The primary aim of this study is to address the long term natural history of possible weight loss associated valvulopathy by re-examining the origin cohort of patients who received the combination fenfluramine-phentermine beginning in 1983 as a part of an NIH sponsored clinical trial performed at this institution. A secondary aim is to test the hypothesis that patients with valvulopathy have an enhanced reaction to drugs which effect serotonin compared with exposed patients who have not developed valvulopathy and unexposed control patients.